Healthcare Provider Details

I. General information

NPI: 1144338245
Provider Name (Legal Business Name): MICHAEL R. KILUK R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31700 VAN DYKE AVE
WARREN MI
48093-7949
US

IV. Provider business mailing address

20600 ERBEN ST
SAINT CLAIR SHORES MI
48081-1798
US

V. Phone/Fax

Practice location:
  • Phone: 586-276-8040
  • Fax: 586-276-8039
Mailing address:
  • Phone: 586-775-7861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302024732
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: